Online Forms

Universal Health Institute offers our patient form(s) online so you can complete it in the convenience of your own home or office.

Chiropractic Doctor Patients with (please click on the topic with your main complaint):

Back Pain
Neck Pain
Headaches

Nutrition Consults (Please note, this packet includes additional paperwork, please make sure to complete everything before your appointment, Thank You.)

Health Questionnaire form (NTAF) can be downloaded here

Children Health Questionnaire (CNNQ) can be downloaded here

Are you expecting?  Congratulations!  Pregnant Patients click here

Medical Doctor Patients click here

Medicare Patients click here - please complete this paperwork if Medicare is your Primary or Secondary Insurance.  Please note, Medicare will not pay for certain services.  We will do our best to let you know which services will be covered at the meeting with our Account Supervisor after your initial visit. 

Please make sure your paperwork is complete before your visit.  You may call the clinic at 312.266.9090 if you have any questions.  If your paperwork is not complete, your appointment may have to be rescheduled.

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